Postactivation Potentiation for Rehab

When I am wearing my strength coach hat, Postactivation Potentiation (PAP) is an important part of my training programs. Oftentimes it is referred to as Contrast Training, but regardless of what you call it, it can be a great tool to use to improve power and function. But, I don’t just use it in the weight room for my “healthy” athletes, I use it in the rehab setting as well.

Before we jump into how I use it in rehab, let’s look at PAP more in depth. A recent article in NSCA’s Strength and Conditioning Journal had this to say about PAP:

“A vast amount of research has been performed illustrating that the execution of certain conditioning activities at maximal or near-maximal intensities can acutely enhance subsequent athletic performance given sufficient recovery. This phenomenon is known as postactivation potentiation (PAP) and its use within the field of strength and conditioning has grown rapidly as performance enhancing effects have been demonstrated within athletic movements such as jumping and sprinting. There are several suggested mechanisms behind PAP, including the recruitment of higher order motor units, increase in pennation angle, and the phosphorylation of myosin regulatory light chains. Regardless of the mechanism involved, the aim of incorporating PAP protocols into an athlete’s training program is to elicit an acute enhancement in performance.”

Essentially, with PAP, you are utilizing specific strength and/or power exercises combined with proper timing and recovery to elicit an acute response that improves a specific output (usually increased strength and/or power).

What is Postactivation Potentiation?

There are a variety of ways that you can accomplish PAP, but all are working with the nervous system to recruit more motor units at the right time and in the right sequence to improve performance. When we repeat the high recruitment strategies over time, the nervous system becomes more efficient in those patterns and improves performance.

Most PAP is accomplished by using a high intensity strength exercise combined with a power exercise to improve performance. A commonly used form of PAP is performing 3-5 low volume sets (2-4 reps) at 80-90% of a 1 rep max with timed intervals (usually 1-2 minutes) and then go directly to sprint training (or jump training). Similar protocols are also used with olympic lifts, plyometrics and sporting activities such as sprinting and jumping. The theoretical construct of this training technique is that a high intensity strength movement recruits a high number of motor units which then are easily stimulated and activated to achieve a very specific speed and power goal.

Another technique that I prefer is to combine several strength and power exercises together into a superset. The concept here is to combine strength and power back to back within a training setting. It is easy to do in the weight room and research has supported it’s use for speed and power sports. An example of this technique would be to perform a set of heavy back squats (strength) and immediately follow it with squat jumps (power). The squat recruits a high number of motor units and the jumps train them to work with speed and explosiveness. When I’m in a great facility with access to vibration, I really like to add that as well. In that case, the set looks something like this:

Vibration squat hold (high amplitude) x 20″

Back squat (90% of 1RM) x 3

Squat jump x 10

Rest and repeat for 3-5 sets

We can mix and match with a number of different exercises and movements. The idea is simple though, combine strength and power together. Some examples could be front squat, lunge, split squat, scissor jumps, box jumps, broad jumps, etc.

My experience with athletes over the years tells me that this technique is as effective as olympic lifting for power development and doesn’t require nearly the learning curve that is required for cleans, snatches and so on. That’s not to say that those movements don’t have a place in a good program, but there is a lot of bang for your buck with PAP training due to the short learning curve and positive outcomes.

What does this have to do with rehab?

As most of you know, I’m a movement guy. Meaning, the sooner I get all of my patients moving (regardless of age, activity level, injury, etc), the better off they are. My rehab programming is basically a regression of my high level strength and conditioning programs. Thus, integrating PAP is a natural fit for my rehab patients, regardless of age or activity level. I basically just modify the progressions to fit them.

Obviously this isn’t a good fit for an acute patient or someone who is a fresh out of a surgical procedure. It is a good fit for patients who are longer term rehabs and need to get stronger and move more efficiently (a lot of our patients). Using PAP as part of their strength program will pour gasoline on your traditional strength rehab. If you are willing to try it, you fill find that your patients get stronger faster than without it.

You may have to be creative with how you use it though. If you have a middle age male who is returning from knee surgery, or maybe an open fixation of their lower leg, this can work well for them. Maybe they don’t need to improve their vertical jump, so scissor jumps and/or squat jumps may not be a great fit for them, but putting them on a shuttle and performing jumps with a lighter load in conjunction with a bodyweight squat is a great modification for them that uses the highly effective principles of PAP.

It can and should be used for the upper extremity as well. Taking someone in a later stage of a shoulder labral repair and combining a pushup with a standing medicine ball pass is a great way to integrate PAP and get them strong, stable and powerful quickly.

And of course, returning an athlete to full play is a natural fit as part of their final stages of rehab, whether that is week 3 of a grade 1+ lateral ankle sprain or month 6 of an ACL repair rehab progression. Running and jumping are a huge part of athletic performance and using PAP in their rehab programming is important for bridging the gap to the weightroom.

As long as you are keeping it tolerable and attainable for the patient, feel free to play within the framework of PAP. Modify loads and body positions for strength training and use things like bands, harnesses, and machines to help you integrate power training in a simple and tolerable manner.

It may not be right for grandma with a thoracic compression fracture, but I do think PAP can and should be used for a lot of our rehab patients. With a little bit of creativity, you can take this effective strategy and make it work for most of your rehab patients.

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